PB2295: TITLE OF MANUSCRIPT: ESTABLISHING A TRANSNATIONAL HAEMATO-ONCOLOGY CANCER MULTIDISCIPLINARY TEAM DURING THE COVID-19 PANDEMIC IN A RESOURCE LIMITED SETTING
Authors: Mohammad Aminul Islam, Amin Lutful Kabir, Zahed Khan, Mahbubur Rahman, Mohammad Abdul Aziz, Rumana Rashid, Col Huque Mahfuz, Col. Mohammed Mosleh Uddin, Afrose Salma, Shahed Chowdhury, Farida Arjuman, Mostafa Sumon, Tasbirul Islam, Jonathan Mo
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: COVID-19 pandemic has created unprecedented hurdles to the delivery of timely care to patients with cancer even in most of developed nations. Patients with haematological malignancies are at even greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression lymphopenia and immunosuppression. Developed nations have taken measures to address these challenges, but patient needs are particularly challenged in countries with limited resources. Many affluent patients had access to treatment overseas during the pre-pandemic era but this is no longer an option in many instances. In June 2020, colleagues from leading teaching hospitals in Bangladesh promptly contacted the United Kingdom-Bangladesh Health Link for guidance on treatments of patients with haematological malignancies, including on-going patient monitoring, with implementation of telemedicine. Meetings with the Haematology Society of Bangladesh and Planetary Health Academia were held. Formal monthly multidisciplinary team’s meetings agreed, in June 2021. Members included haematologist, haemato-oncologist, radiologists, histopathologists, clinical oncologists and cancer nurse specialists. MDTs are well established and mandatory for cancer care to practice evidence-based medicine and reviewing the quality of management decisions in developed nations, yet to be adopted in resource limited settings Aims: The primary aim was to establish the first transnational haemato-oncology cancer MDT in Bangladesh in the treatment of haemato-oncology patients during the COVID-19 pandemic. Methods: Retrospective observational study, July 2020-December 2021. Case records printed and electronic laboratory data radiology, histology of adult patients were examined. Cases summaries submitted to a senior haematologist via the MDT central coordinator. Selected cases shared with the MDT members via secured email. MDTs conducted via zoom link and relevant physicians and trainees were invited to participate. Informed consent was obtained. Institutional authority approved the study. Results: Reviewed 192 cases as of 31st December 2021. The median was 56 (23-83) years, 103 males and 89 females, 153 (79.68%) cases that were confirmed as relapsed cases. Median previous therapies were 2 (2-4) lines. A third of the patients (56 or 29% of 192) intended to seek treatment overseas if there were no pandemic restrictions. Diagnosis included high grade lymphoma (35), Classical Hodgkin’s Lymphoma (10), low grade lymphoma (22), multiple myeloma (20), acute lymphoblastic leukaemia (16), acute myeloid leukaemia (26), CNS lymphoma (5), Langerhans cell histiocytosis (4), stem cell transplantations (15). Diagnosis revised in 18 (9.37 %) additional specialised tests recommended (8 high grade NHL, 6 low grade NHL, 2 ALL and 2 LCH). 39 (20.31%) were investigated for suspected haematological cancers. Recommended salvage therapies for 135 (70.31 %) of patients in Bangladesh. Summary/Conclusion We established a novel opportunity for haematological cancer care for Bangladesh particularly during the COVID-19 pandemic. The combination of appropriate medical expertise and electronic communications advantages allowed us to provide improved management directions/decisions in a timely manner. It is quite likely that this approach resulted in many patients achieving remission or even cure. Otherwise, these cases may have been managed with a palliative approach. To the best of our knowledge, this is the first such initiative in Bangladesh and may be used as a model for patient care in other resource-limited countries. The limitation of this pilot project is the lack of data on long term outcomes. Keywords: Lymphoid malignancy, Clinical outcome, Lymphoma, Mantle cell lymphoma